Peroral Cholangioscopy/Pancreatoscopy

  • Wei-Chi Sun
  • Hoi-Hung Chan


With the advances of high-quality and noninvasive imaging techniques such as endoscopic ultrasound (EUS), computed tomography (CT), and magnetic resonance cholangiopancreatography (MRCP), the application of diagnostic endoscopic retrograde cholangiography (ERCP) has markedly decreased in the diagnosis of biliopancreatic disease [1]. ERCP can effectively show the anatomy of the biliary tract and define any strictures or filling defects. However, cytology and biopsy by ERCP-guided method has the best and modest sensitivity in differential diagnosis of benign and malignant lesions. Every endoscopist wishes to glimpse the internal structure of the biliary tract. Nowadays, the biliary tract can be accessed by endoscopy via the oral route. In this chapter, we will review the history, clinical applications, complications, and limitations of currently available peroral cholangioscopes (POC).


Cholangioscopy Choledochoscope Choledocholithiasis Cholangiocarcinoma Lithotripsy 


  1. 1.
    Devereaux CE, Binmoeller KF. Endoscopic retrograde cholangiopancreatography in the next millennium. Gastrointest Endosc Clin N Am. 2000;10(1):117–33. viiPubMedGoogle Scholar
  2. 2.
    Nakajima M, Akasaka Y, Fukumoto K, et al. Peroral cholangiopancreatosocopy (PCPS) under duodenoscopic guidance. Am J Gastroenterol. 1976;66(3):241–7.PubMedGoogle Scholar
  3. 3.
    Urakami Y, Seifert E, Butke H. Peroral direct cholangioscopy (PDCS) using routine straight-view endoscope: first report. Endoscopy. 1977;9(1):27–30.CrossRefPubMedGoogle Scholar
  4. 4.
    Itoi T, Neuhaus H, Chen YK. Diagnostic value of image-enhanced video cholangiopancreatoscopy. Gastrointest Endosc Clin N Am. 2009;19(4):557–66.CrossRefPubMedGoogle Scholar
  5. 5.
    Chen YK. Preclinical characterization of the Spyglass peroral cholangiopancreatoscopy system for direct access, visualization, and biopsy. Gastrointest Endosc. 2007;65(2):303–11.CrossRefPubMedGoogle Scholar
  6. 6.
    Parsi MA, Stevens T, Collins J, et al. Utility of a prototype peroral video cholangioscopy system with narrow-band imaging for evaluation of biliary disorders (with videos). Gastrointest Endosc. 2011;74(5):1148–51.CrossRefPubMedGoogle Scholar
  7. 7.
    Shim CS, Neuhaus H, Tamada K. Direct cholangioscopy. Endoscopy. 2003;35(9):752–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Draganov PV, Chauhan S, Wagh MS, et al. Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study. Gastrointest Endosc. 2012;75(2):347–53.CrossRefPubMedGoogle Scholar
  9. 9.
    Chen YK, Parsi MA, Binmoeller KF, et al. Single-operator cholangioscopy in patients requiring evaluation of biliary tract disease or therapy of biliary stones (with videos). Gastrointest Endosc. 2011;74(4):805–14.CrossRefPubMedGoogle Scholar
  10. 10.
    Tischendorf JJ, Kruger M, Trautwein C, et al. Cholangioscopic characterization of dominant biliary tract stenoses in patients with primary sclerosing cholangitis. Endoscopy. 2006;38(7):665–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Hoffman A, Kiesslich R, Moench C, et al. Methylene blue-aided cholangioscopy unravels the endoscopic features of ischemic-type biliary lesions after liver transplantation. Gastrointest Endosc. 2007;66(5):1052–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Hoffman A, Kiesslich R, Bittinger F, et al. Methylene blue-aided cholangioscopy in patients with biliary strictures: feasibility and outcome analysis. Endoscopy. 2008;40(7):563–71.CrossRefPubMedGoogle Scholar
  13. 13.
    Azeem N, Gostout CJ, Knipschield M, et al. Cholangioscopy with narrow-band imaging in patients with primary sclerosing cholangitis undergoing ERCP. Gastrointest Endosc. 2014;79(5):773–9. e2CrossRefPubMedGoogle Scholar
  14. 14.
    Ramchandani M, Reddy DN, Gupta R, et al. Role of single-operator peroral cholangioscopy in the diagnosis of indeterminate biliary lesions: a single-center, prospective study. Gastrointest Endosc. 2011;74(3):511–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Clozel M, Clyman RI, Soifer SJ, et al. Thromboxane is not responsible for the high pulmonary vascular resistance in fetal lambs. Pediatr Res. 1985;19(12):1254–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Cennamo V, Luigiano C, Fabbri C, et al. Cholangioscopy using a new type of cholangioscope for the diagnosis of biliary tract disease: a case series. Endoscopy. 2012;44(9):878–81.CrossRefPubMedGoogle Scholar
  17. 17.
    Hayashi S, Baba Y, Ueno K, et al. Small arteriovenous malformation of the common biliary tract causing hemobilia in a patient with hereditary hemorrhagic telangiectasia. Cardiovasc Intervent Radiol. 2008;31(Suppl 2):S131–4.CrossRefPubMedGoogle Scholar
  18. 18.
    Prasad GA, Abraham SC, Baron TH, et al. Hemobilia caused by cytomegalovirus cholangiopathy. Am J Gastroenterol. 2005;100(11):2592–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Albert JG, Friedrich-Rust M, Elhendawy M, et al. Peroral cholangioscopy for diagnosis and therapy of biliary tract disease using an ultra-slim gastroscope. Endoscopy. 2011;43(11):1004–9.CrossRefPubMedGoogle Scholar
  20. 20.
    XL L, Itoi T, Kubota K. Cholangioscopy by using narrow-band imaging and transpapillary radiotherapy for mucin-producing biliary tract tumor. Clin Gastroenterol Hepatol. 2009;7(6):e34–5.CrossRefGoogle Scholar
  21. 21.
    Siddique I, Galati J, Ankoma-Sey V, et al. The role of choledochoscopy in the diagnosis and management of biliary tract diseases. Gastrointest Endosc. 1999;50(1):67–73.CrossRefPubMedGoogle Scholar
  22. 22.
    Lai KH, Chan HH, Tsai TJ, et al. Reappraisal of endoscopic papillary balloon dilation for the management of common biliary tract stones. World J Gastroenterol Endosc. 2015;7:77–86.CrossRefGoogle Scholar
  23. 23.
    Sethi A, Chen YK, Austin GL, et al. ERCP with cholangiopancreatoscopy may be associated with higher rates of complications than ERCP alone: a single-center experience. Gastrointest Endosc. 2011;73(2):251–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Chen YK, Pleskow DK. SpyGlass single-operator peroral cholangiopancreatoscopy system for the diagnosis and therapy of bile-duct disorders: a clinical feasibility study (with video). Gastrointest Endosc. 2007;65(6):832–41.CrossRefPubMedGoogle Scholar
  25. 25.
    Larghi A, Waxman I. Endoscopic direct cholangioscopy by using an ultra-slim upper endoscope: a feasibility study. Gastrointest Endosc. 2006;63(6):853–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Moon JH, Ko BM, Choi HJ, et al. Intraductal balloon-guided direct peroral cholangioscopy with an ultraslim upper endoscope (with videos). Gastrointest Endosc. 2009;70(2):297–302.CrossRefPubMedGoogle Scholar
  27. 27.
    Efthymiou M, Raftopoulos S, Antonio Chirinos J, et al. Air embolism complicated by left hemiparesis after direct cholangioscopy with an intraductal balloon anchoring system. Gastrointest Endosc. 2012;75(1):221–3.CrossRefPubMedGoogle Scholar
  28. 28.
    Meves V, Ell C, Pohl J. Efficacy and safety of direct transnasal cholangioscopy with standard ultraslim endoscopes: results of a large cohort study. Gastrointest Endosc. 2014;79(1):88–94.CrossRefPubMedGoogle Scholar
  29. 29.
    Pohl J, Meves VC, Mayer G, et al. Prospective randomized comparison of short-access mother-baby cholangioscopy versus direct cholangioscopy with ultraslim gastroscopes. Gastrointest Endosc. 2013;78(4):609–16.CrossRefPubMedGoogle Scholar
  30. 30.
    Choi HJ, Moon JH, Ko BM, et al. Overtube-balloon-assisted direct peroral cholangioscopy by using an ultra-slim upper endoscope (with videos). Gastrointest Endosc. 2009;69(4):935–40.CrossRefPubMedGoogle Scholar
  31. 31.
    Takaoka M, Shimatani M, Ikeura T, et al. Diagnostic and therapeutic procedure with a short double-balloon enteroscope and cholangioscopy in a patient with acute cholangitis due to hepatolithiasis. Gastrointest Endosc. 2009;70(6):1277–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Matsushita M, Shimatani M, Takaoka M, et al. Effective peroral direct cholangioscopy with an ultraslim gastroscope in combination with a short double-balloon enteroscope for altered GI anatomy. Gastrointest Endosc. 2012;76(5):1075.CrossRefPubMedGoogle Scholar
  33. 33.
    Fukuda Y, Tsuyuguchi T, Sakai Y, et al. Diagnostic utility of peroral cholangioscopy for various bile-duct lesions. Gastrointest Endosc. 2005;62(3):374–82.CrossRefPubMedGoogle Scholar
  34. 34.
    Kim HJ, Kim MH, Lee SK, et al. Tumor vessel: a valuable cholangioscopic clue of malignant biliary stricture. Gastrointest Endosc. 2000;52(5):635–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Awadallah NS, Chen YK, Piraka C, et al. Is there a role for cholangioscopy in patients with primary sclerosing cholangitis? Am J Gastroenterol. 2006;101(2):284–91.CrossRefPubMedGoogle Scholar
  36. 36.
    Itoi T, Sofuni A, Itokawa F, et al. Peroral cholangioscopic diagnosis of biliary-tract diseases by using narrow-band imaging (with videos). Gastrointest Endosc. 2007;66(4):730–6.CrossRefPubMedGoogle Scholar
  37. 37.
    Fishman DS, Tarnasky PR, Patel SN, et al. Management of pancreaticobiliary disease using a new intra-ductal endoscope: the Texas experience. World J Gastroenterol. 2009;15(11):1353–8.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Piraka C, Shah RJ, Awadallah NS, et al. Transpapillary cholangioscopy-directed lithotripsy in patients with difficult biliary tract stones. Clin Gastroenterol Hepatol. 2007;5(11):1333–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyKaohsiung Veterans General HospitalKaohsiungTaiwan
  2. 2.School of MedicineNational Yang Ming UniversityTaipeiTaiwan
  3. 3.College of Pharmacy and Health CareTajen UniversityYanpuTaiwan
  4. 4.Department of MedicineNational Defense Medical CenterTaipeiTaiwan

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